The American Academy of Family Physicians agrees the Affordable Care Act will increase demand for primary-care services. While there will be a shortage of primary-care physicians, there will also be a far worse shortage of nurses. According to the American Association of Colleges of Nursing, we will face a shortage of 260,000 nurses by 2025. Moreover, states that grant independent practice to nurse practitioners still have the same high-cost, accessibility and fragmented care challenges as states that require collaboration.

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We need both primary-care physicians and nurse practitioners — not one or the other — to meet this increased demand. The AAFP advocates for delivery models that deploy physician-led teams of health care professionals. Research demonstrates that the use of teams not only improves quality of care but also expands the reach of the primary-care workforce.

The authors write that “extensive research finds they are able to handle 80 to 90 percent of primary-care cases — and achieve outstanding results.” This is disingenuous. In 2011, researchers at the University of Missouri conducted a meta-analysis of many of these nurse practitioner studies. They found many focused on a specific illness or condition — not whole-person, comprehensive primary care. In short, nurse practitioners perform well in studies that analyze only patient satisfaction. NPs also provide quality care to patients who fall within a defined treatment protocol. But we cannot conclude that these results mean nurse practitioner care supersedes primary-physician care.

Scope of practice and licensure laws are designed to protect and promote patient safety. They are a credible guarantee that the health care provider has achieved an acceptable level of education and training that ensures his or her competency to provide services to patients. While the article suggests a standardized educational and licensing process for NPs, such standardization is not reality. The requisite education, training and even licensure for NPs varies tremendously from state to state. Removing those licensure restrictions and allowing NPs to practice medicine independent of a team approach will not serve our patients or our country well.

Finally, we must define the collaborative relationship in today’s delivery system. It means the family physician and NP work together to maximize their individual talents and skills and to provide the highest quality of care to their patients. It is time for us to move beyond policies that further fragment health care and move collectively toward building collaborative teams that will increase access and improve quality of care.

Reid Blackwelder, M.D., president-elect, American Academy of Family Physicians